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Lasers in Periodontics

 A discussion in "periotherapist group"

As a practicing hygienist for over 30 years who has tried every treatment 
to help my perio pts, I now have a tool that will let me do just that. 
Patients treated with my DEKA CO2 Ultraspeed after SRP have decreased or 
no bleeding sites, decreased pocket depths and decreased colonized and motile 
bacteria....nothing else will do this with predictable results. SRPs alone may
result in decreased (although usually minimal) pocket depths and temporarily 
decreased bleeding sites, it does not reduce colonized bacteria for longer
than 7 -10 days. Even patients with non-existent home care look better at 
recall after being treated with this laser. I also know that the level of 
laser (light) energy that I am using is not hurting my patients in
any way....can you say that about Arestin??? or about scaling root surfaces 
so smooth that fibers can not reattach???

So that said, Im on board. I dont need to wait 5-10+ years for the research 
to prove that my results are accurate and reduceable and predictable....
my patients need to be healthier now. Perio disease is not a local infection 
and the associated bacteria (treponema denticola) course through the body 
attaching in other sites (the heart, the brain). As someone  earlier stated, 
education of patients is a must. Patients won't value what they dont understand.

In regard to return on investment, there is no other tool that you can bring 
into a dental office and create the same return on investment. Procedures 
done with this laser have no associated lab bill or component parts...the 
revenue goes right to the bottom line. I am using the laser to treat perio, 
but it is a surgical laser and my doctor performs many procedures in our 
office that would have been referred out or (more likely) not done....who 
wants soft tissue surgical procedures done with a blade when they can be 
done bloodlessly, with no sutures and minimal if any post op pain...
its a no brainer.

You mentioned that you talked with some hygienists using a diode and their 
results were spotty... talk with some hygienists using the DEKA CO2 Ultraspeed 
(the new generation of CO2 lasers) and see what they have to say.

Again I suggest that you attend a Standard Proficiency Course....its a great 
way to get info from one of the country's leading experts in all things 
laser dentistry. Lasers in dentistry are here to stay....learn all you can 
from those at the top of the field! - Laurie King, RDH MS   8th Sep 2008

Abstract
Journal of Periodontology
2006, Vol. 77, No. 4, Pages 545-564
Lasers in Periodontics: A Review of the Literature

Charles M. Cobb

Background: Despite the large number of publications, there is still controversy among clinicians regarding the application of dental lasers to the treatment of chronic periodontitis. The purpose of this review is to analyze the peer-reviewed research literature to determine the state of the science concerning the application of lasers to common oral soft tissue problems, root surface detoxification, and the treatment of chronic periodontitis.

Methods: A comprehensive computer-based search combined the following databases into one search: Medline, Current Contents, and the Cumulated Index of Nursing and Allied Health. This search also used key words. In addition, hand searches were done for several journals not cataloged in the databases, and the reference lists from published articles were checked. All articles were considered individually to eliminate non-peer-reviewed articles, those dealing with commercial laser technology, and those considered by the author
to be purely opinion articles, leaving 278 possible articles.

Results: There is a considerable conflict in results for both laboratory studies and clinical trials, even when using the same laser wavelength. A meaningful comparison between various clinical studies or between laser and conventional therapy is difficult at best and likely impossible at the present. Reasons for this dilemma are several, such as different laser wavelengths; wide variations in laser parameters; insufficient reporting of parameters that, in turn, does not allow calculation of energy density; differences in experimental design, lack of proper controls, and differences in severity of disease and treatment protocols; and measurement of different clinical endpoints.

Conclusions: Based on this review of the literature, there is a great need to develop an evidence-based approach to the use of lasers for the treatment of chronic periodontitis. Simply put, there is insufficient evidence to suggest that any specific wavelength of laser is superior to the traditional modalities of therapy. Current
evidence does suggest that use of the Nd:YAG or Er:YAG wavelengths for treatment of chronic periodontitis may be equivalent to scaling and root planing (SRP) with respect to reduction in probing depth and subgingival bacterial populations. However, if gain in clinical attachment level is considered the gold standard for non-surgical periodontal therapy, then the evidence supporting laser-mediated periodontal treatment over traditional therapy is minimal at best. Lastly, there is limited evidence suggesting that lasers used in an adjunctive capacity to SRP may provide some additional benefit.

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